BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street, Stockton, CA 95202-3029 Telephone: (209) 468-3420 Fax: (209) 468-3433 Web:www.sjgov.org/ehd ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM Facility Mame: Ll� To Page of — Facility Address: IZ Inspection Date:LLai- I'C - (3 FA#: PR M Program Element: Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum 21,320 gallons in tanks* and containers". Complete one box for each tank or each cumulative container product type. Tank (2820) ❑ Containers (2821) #of rs: TA#: 1 Product Type: r ()Lf ✓ Total Capacity: ((�' _gallons (per tank or cumulative for containers by product type) Install Date: Y Tank (2820) ❑ Contai #of Containers: TA#: 2 Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: (2820) ❑ Containers (2821) #of Containers: TA#: 3 Product Type: U by 41 LI Total Capacity: gallons I (per tank or cumulative for containers by produ type) Install Date: Tank (2820) ❑ Containers (2821) #of Containers: TA#: 4 Product T Total Capacity: '(�-; gallons Type: Y ,��' ank or cumulative for containers by product type) Install Date: h,Tank (2820) ❑ Containers (2821) #of Containers: TA#: ,9, 5 C Product Type: Total Capacity: � %' gallons r-A l �i e ) (per tank or cumulative for containers by product type) Install Date: }V� �a I ' Iyu C r- Total Capacity this Page: 3a 1 j gallons Total Capacity for Site: S gallons Comments: EHD Inspector: Reviewed Date: Entered Date: By Initial: �vl� O I�3 By Initial: i / ! J *Ab veground storage tank means a tank that has the capacity to store 55 gallons or more of petroleum. **Container means a storage device designed to be moved when full. EHD 28-01 09/12/08 AST SURVEY FORM